Rheumatoid arthritis (RA) is a chronic multi system disorder with predominant findings in the diarthroidal joints. Estimates of the prevalence of RA vary from 0.5% in some rural African communities to 5% among some Native American tribes. The clinical manifestations vary tremendously from mild synovial inflammation that is easy to control to a multi system inflammatory disease that progresses despite aggressive immunotherapy. The factors that predict disease severity and disease outcome are poorly understood. Genetic factors, such as the shared epitope, have been shown to play a significant role in disease susceptibility and severity among some Caucasians, but the data in African Americans and other racial groups are weak and variable. There are likely other genes that are important and there are data that suggests that disease expression in RA is multigenic. Little is understood about the role of socioeconomic status, environmental factors and health behaviors in the expression of RA in most populations. Since there are likely multiple genes and these genes may be predictive of the clinical characteristics of the disease, data on genotype is only useful if the disease phenotype is well characterized. One of the weaknesses of much of the research on the immunogenetics of RA is the failure to correlate the genetic data with solid clinical, patient-based information. Comprehensive and complete evaluation of patient-based factors and clinical status will allow us to better understand the meaning of the genotype and allow us to make more rational predictions about disease course and outcome based on the genetic data. In addition, we will have the opportunity to better study the interaction between genetic and environmental factors in the future. The purpose of this project is to develop a prospective, longitudinal, cohort study of RA among residents of North Carolina. The patients will come from the University of North Carolina Rheumatology and Orthopedic Clinics and the 10 Rheumatology practices throughout the state that comprise the participants of the North Carolina Arthritis Health Project. a cohort representative of both tertiary care and community based practices. The major focus of these studies is to determine the role of socioeconomic status, attitudes, health behaviors, and genetics in determining severity and damage in RA.